Basic Information
| Provider Information | |||||||||
| NPI: | 1376007229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IANOVSKI | ||||||||
| FirstName: | ANDREY | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 860 WEIDNER RD APT 502 | ||||||||
| Address2: | |||||||||
| City: | BUFFALO GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600894753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402126885 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8661 S HOWELL AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | OAK CREEK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531542919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148470164 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2019 | ||||||||
| LastUpdateDate: | 01/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 353735 | WI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.